Provider Demographics
NPI:1629228564
Name:MEDCARE LIFE LLC
Entity Type:Organization
Organization Name:MEDCARE LIFE LLC
Other - Org Name:MEDCARE LIFE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DIRTRICT SALES MGR
Authorized Official - Phone:205-251-1239
Mailing Address - Street 1:2517 30TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207
Mailing Address - Country:US
Mailing Address - Phone:205-251-1239
Mailing Address - Fax:205-251-1066
Practice Address - Street 1:2517 30TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207
Practice Address - Country:US
Practice Address - Phone:205-251-1239
Practice Address - Fax:205-251-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08018232332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies